Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is an anxiety disorder that causes a person to have a distorted view of how they look and to spend a lot of time worrying about their appearance.

For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal.

Having BDD does not mean the person is vain or self-obsessed.

When does low confidence turn into BDD?

Almost everyone feels unhappy about the way they look at some point in their life, but these thoughts usually come and go, and can be forgotten.

However, for someone with BDD, the thoughts are very distressing, do not go away and have a significant impact on daily life.

The person believes they are ugly or defective and that other people perceive them in this way, despite reassurances from others about their appearance.

Who is affected

It's estimated that up to one in every 100 people in the UK may have BDD, although this may be an underestimate as people with the condition often hide it from others. BDD has been found to affect similar numbers of males and females.

The condition can affect all age groups, but usually starts when a person is a teenager or a young adult, when people are generally most sensitive about their appearance.

Typical behaviours of someone with BDD

BDD can seriously affect daily life, often affecting work, social life and relationships.

A person with BDD may:

constantly compare their looks to other people's

spend a long time in front of a mirror, but at other times avoid mirrors altogether

spend a long time concealing what they believe is a defect

become distressed by a particular area of their body (most commonly their face)

feel anxious when around other people and avoid social situations

be very secretive and reluctant to seek help, because they believe others will see them as vain or self-obsessed

seek medical treatment for the perceived defect – for example, they may have cosmetic surgery, which is unlikely to relieve their distress

excessively diet and exercise

Although BDD is not the same as OCD, there are some similarities. For instance, the person may have to repeat certain acts, such as combing their hair, applying make-up, or picking their skin to make it "smooth".

Cognitive behavioural therapy (CBT)

CBT is a type of therapy that can help you manage your problems by changing the way you think and behave. You'll work with the therapist to agree on some goals – for example, one aim may be to stop obsessively checking your appearance.

An important element of CBT for treating BDD is known as graded exposure and response prevention (ERP). This involves facing situations where you would normally think obsessively about your appearance, so you are able to gradually cope better with these situations over time.

As part of your therapy, you may also be given some self-help materials to use at home and you may be invited to participate in some group work.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant that increase the levels of a chemical called serotonin in your brain. Serotonin is a chemical that the brain uses to transmit information from one brain cell to another.

A number of different SSRIs are available, but most people with BDD will be prescribed a course of fluoxetine.

Your medication should be taken daily and it may take 12 weeks before it has an effect. If it's effective, this treatment should continue for at least 12 months, to allow for further improvements and prevent a relapse.

When the treatment is complete and your symptoms are under control, the SSRI dose should be reduced gradually to minimise the possibility of withdrawal symptoms.